142 



OPERATIVE TECHNIQUE. 



are either the muscular or serous coats, the latter of which shows a 

 great readiness to adhere and unite. Sutures must also ensure perfect 

 closure of the bowel woimd and absolutely prevent bowel contents 

 exuding. They should, therefore, be inserted about every one 

 eighth of an inch. On account of the thinness of the walls slender 

 needles are necessary. Special fine curved needles or fine sewing 

 needles can be employed. Aseptic silk is probably the best sewing 

 material ; catgut is less adapted for the purpose as it is sometimes too 



Fig. 



— Schema of Jobert's suture 

 mow abandoned). 



Fig. 169. — Schema showing Jobert' 

 suture in section. 



rapidly absorbed, the sutures yielding before the. union of the surface 

 has occurred. To prevent this, catgut rendered partially insoluble by 

 the action of chromic acid has been introduced, but boiled silk has no 

 such disadvantage and serves every purpose. 



The first and simplest form of suture was Jobert's. The needle was 

 first passed through the serosa at some distance from the wound. 



Fig. 170. — Lembert's bowel stitch. 



Fig. 171. — Lembert-Czerny bowel stitch. 



penetrated the entire thickness of the bowel, and emerged close to the 

 free border of the wound. The opposite lip of the wound was transfixed 

 in a similar way. The ends were then knotted together and cut off 

 (Fig. 168). This suture brought the serous coats into apposition, as 

 shown in Fig. 169, but had the disadvantage that the threads passed 

 through the lumen of the bowel, and might thus convey septic material 

 from it into the peritoneal cavity, producing infection and inflammation 

 in the track of the suture, resulting later in peritonitis. 



